Farewell to Rwanda

 The initial draft of this post is being written as we are in our Kigali hotel room, waiting for the shuttle to take us to the airport for our Wednesday 9:30PM flight (to Entebbe, then Amsterdam, then Detroit, then to Grand Rapids) arriving home after a 27 hour journey!

Our last 10 days at Kibogora went quickly. We had a delightful but rigorous 7 mile roundtrip hike with 5 others to the shore of Lake Kivu where Susie and 4 others went for a swim.

We rode to Kigali this past Saturday and have enjoyed a few days of splendid Rwandan tourism! We had a 2 day tour planned and had an excellent driver who navigated the incredible traffic of downtown Kigali. We spent several hours at the Genocide Museum which was very emotionally moving – it is the final resting place of over 100,000 of the one million Tutsi and moderate Hutus who were killed in the 1994 genocide that lasted only 100 days. Pictures were not allowed inside the museum – all we can say is that it was very reminiscent of Yad Vashem Museum in Jerusalem or the Dachau concentration camp outside of Munich. The stunning cruelty of people towards each other was almost incomprehensible!

Then, after a 2 ½ hour drive to northern Rwanda, we arrived at the home of the mountain gorillas!! We had an overnight in a lodge reminiscent of those we have stayed in on Kenyan safaris and then, on Tuesday the 18^th, we made the short drive to Volcanoes National Park where we joined a group of 6 others for a trek up the mountain in search of gorillas! After about an hour of very difficult uphill climbing over rocks, in mud, and over vines, our two guides told us that the gorilla family that we had been assigned to was nearby. Thankfully, we had hired porters not only to carry our backpacks but to give us a hand on the more difficult terrain. We were AMAZED by the gorillas. Lysenga was the dominant male, or silverback, of the family that we were with. He was joined by several females, juveniles, and babies. We were able to watch them for an hour. Lysenga was not bothered by our presence and almost seemed to be ignoring us. He sat about 15 feet away from us before plopping down six feet from us for a halfhour nap, not bothered by his children playing nearby.

Goodbye to our friend Dr. Pacifique.

A dip in Lake Kivu after a strenuous hike.

On a Sunday afternoon, a view showing a well-kept boulevard in Kigali. The roads were, in general, the best we have encountered in our African adventures.

Below, the weekday traffic in Kigali is very heavy with cars, buses, trucks, motorcycle taxis, and bicycles all vying for road space. Driving here takes nerves of steel!

At the Mountain Gorilla View Lodge with our excellent driver Danny.

First sighting of 24 year old Lysenga, the silverback "boss" of his family of about a dozen gorillas.

Lysenga seemed indifferent to our presence.

 Here he is, striking his "I am the boss" pose. One of the other trekkers is close behind him.

After sitting about 15 feet from us, Lysenga casually walked over and plopped down for a nap about 6 feet from us. We were amazed!!!!!! Some family members joined him for naptime while a few younger kids played nearby.

Susie with one of our guides with the volcanos in the background. Our trek took us onto the hills on the left .

Farewell to our two excellent guides, Emmanuel and Christophe, who safely guided us to the gorillas and taught us many things about their behavior and habitat.

Eglise Methodiste Libre Au Rwanda (E.M.L.R.)

 Kibogora Hospital is a ministry of the Free Methodist Church of Rwanda. Just outside the hospital gate is the local church which we have attended. It is a large building with a sanctuary that seats somewhere around 600-700 people. Sunday services start around 9 AM, are packed, and go for about three hours. The first hour consists of three choirs that rotate onto the stage with wonderful singing and swaying to the music; the words are projected onto two screens in Rwandan for the congregation. We don’t understand what they are singing but just enjoy this joyful aspect of African worship. We sit in the back and leave after the singing, since there is no translation of the pastoral message.

There is a separate English language service Sunday afternoon that is attended by around 25 folks. On our first Sunday there, one of the pastors, whom I (Dave) had never met, came up to me and asked me to “preach” two weeks hence! I guess he chose me due to my gray hair or something. I did enjoy talking/teaching (not preaching!) about First and Second Timothy regarding the ministry and management of the local church!

After one of the services, we met several young men from Sudan who were visiting. Also, we met and have spent time with other short-term visitors including nurse Shannon from North Carolina and three Canadians from Calgary: Scott an engineer, his wife Bethany a nurse, and her sister Jessica also a nurse. 

View from back of the sanctuary.

One of the joyful choirs!

Visiting after the English service

                                                                                                                                         

    

With two Sudanese visitors and a pastor.

Guest "preacher"

Walking home after church:
Susie, Shannon, Scott, Bethany, and Jessica

Morning Walk

 Three or four mornings each week, we enjoy a 40 minute walk to the nearby town. The road is very hilly and affords wonderful vistas. Across the valley, we can see the hospital, Lake Kivu, and even the Congo in the distance. At 7 AM, the sidewalks are filled with students in their various uniforms, headed to several nearby schools.  Vendors and stores are mostly closed at that hour but construction projects have begun. Men carry heavy bags of concrete on the back of their bicycles, pushing the bikes up the steep hills – amazing!!

On Saturdays, we walk a bit later and have been able to visit the small “supermarket” which is more like a small 7/11 as well as a pharmacy where drugs are sold over the counter without a prescription – we picked up some inexpensive doxycycline which we will use on future trips for malaria prevention! The highlight of Saturday’s walk is the market with many covered booths selling produce and fruit of all kinds, beans and rice, and many types of flipflop shoes that seem to be very popular here.

The people here are very friendly, especially the children who greet us as we walk.

   

                                                                                  

  

  We pass by two or three schools and each has its own uniform. The children are delightful and call out "Good morning" to practice their English!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

Saturday market day is a flurry of activity. The vendors were reluctant to have their pictures taken so we had to be subtle!!

This is a vegetarian and fruit lovers paradise!!!

       

Motorcycles are lined up just outside of the market in case anyone needs a lift!

We see many partially completed construction projects along the way. We don't know if there are building codes and inspectors!!

.... uphill on a one speed bike!!!!
                                                                                                                                                   

The walk home is a long steep uphill that leaves us huffing and puffing if we take it quickly. Kibogora is at 5000 feet above sea level which is about the same as Denver, Colorado!

Kibogora Hospital

 Kibogora is located about 4 ½ hours by car from the capital city of Kigali and is in the southwest corner of Rwanda, next to Lake Kivu and overlooking the Democratic Republic of the Congo.

The work here was begun as a dispensary in 1942 by Reverend Frank Adamson, a missionary of the Free Methodist Church. Later, under Dr. Al Snyder (from our hometown, Grand Rapids!), services were added and it is now a hospital of over 400 beds with departments including surgery, maternity/obstetrics, pediatrics/neonatology, emergency, internal medicine, physical therapy, palliative care, and dentistry.  Kibogora is a Level 2 Teaching Hospital which allows it to support visiting resident doctors, and it is a referral hospital for 12 surrounding health centers.

Our guesthouse is only a 5 minute walk to the hospital, down a very steep hill. At the gate, a guard greets us and offers us disinfectant hand sanitizer. Susie heads straight ahead to the far end of the courtyard to the Emergency Department while Dave turns right at the gate and descends down another hill to the internal medicine wards.

We are happy to be working with some excellent medical interns who are recent graduates from a new Rwanda medical school, the University of Global Health Equity. Their fund of knowledge and critical thinking skills are quite impressive!

The hospital uses a basic electronic medical record that is actually helpful though a slow internet connection is sometimes an impediment!! We can access patient data on computers at the nursing stations, on our phones, or on handheld tablet notebooks that we can carry on ward rounds. 

To the left is the view from the hospital gate. In the distance is the emergency room, seen below.

Susie is working in the ER with Dr. Pacifique who is one of the excellent Rwandan interns and nurse Shannon, who is visiting from North Carolina!

Dr. Pacifique sharing his stethoscope with Naomi, a delightful 12 year old girl who was sent in all by herself from her boarding school for gastrointestinal complaints. Her exam and tests were benign and she was sent home on several meds. She was articulate, spoke perfect English, and said that she wanted to be doctor!

 Here is a view of one of the internal medicine wards. Each of the male and female wards has several rows of beds - not much privacy but there are moveable curtain partitions that can be brought in when detailed exams are done. Note the mosquito nets hanging over the beds!

Dave is working with Dr. Cesar, another one of the  Rwandan interns who is reviewing a chart at the bedside with 3 nursing students and the ward nurse looking on.

Below is Susie with Dr. Stella, one of the longterm GPs who will soon be leaving to do additional training.
                                                                                                                                                   

                                                                                         

The Green House!!

We are enjoying our stay at the "Green House", named after the color of its keyrings, which is one of the guest houses at Kibogora. There are 4 bedrooms each with private bath, and common areas including a modest kitchen, a living room with a fireplace (not sure how often it is used!), a dining room, and an enclosed porch with a spectacular view over the mountainside with glimpses of Lake Kivu in the distance. Initially, we had planned to prepare our own meals but decided to enjoy breakfasts and dinners prepared by the kitchen along with our traditional "Clif and Earl" lunches.

When we arrived, we were warmly greeted by Bestine, one of the guesthouse workers.

During our first week, we enjoyed visiting with other guests including an orthopod and his wife from Norway and an anesthetist/nurse couple from Wisconsin. Tony the orthopod serenaded us with his ukelele!!     

           Those couples have gone home and this week, we have been joined by two general surgeons from New Hampshire who are busy with endoscopies.

The temps get into the mid 70s during the day and cool into the mid 60s at night - quite pleasant!! 

As it shows below, it is rainy season with periods of heavy rain each day!!!

RWANDA

 Rwanda is a landlocked country lying just below the Equator in East Africa surrounded by Uganda to the north, Tanzania to the east, Burundi to the south, and Congo to the west. It is called the “land of a thousand hills” due to its mountainous nature – the lowest point in the country is 3100 feet above sea level. It’s area is about 10,000 square miles, about the size of Massachusetts.

Rwanda is densely populated with about 14 million people. The capital city of Kigali is located in the center of the country and has a population of about 600,000; it is said to be the cleanest large city in Africa!!    The life expectancy for men is 67 and 71 for women. Around three quarters of the people are literate.  Over 90 percent are Christian, due to the influence of both Protestant and Catholic missionaries.

The weather in Rwanda is temperate with two rainy seasons: February through June and September through December.

The economy of Rwanda is primarily agricultural. Coffee is the main agricultural export.

Healthcare in Rwanda is a decentralized universal system centered around Community-Based Health Insurance which covers most Rwandans with a sliding scale for premiums and gives all citizens access to a network of primary care centers. People needing further care can be referred to one of 42 district hospital or one of the four national referral hospitals.

Rwanda’s history is complex and we look forward to learning more of the details. Very briefly, in the late 1800s, Rwanda was colonized by Germany; Belgium took over during the first World War. The Europeans ruled by way of a Rwandan king and were partial to the Tutsi tribe. The other main tribe, the Hutus, revolted in 1959, massacred many Tutsis, and set up an independent Hutu-led republic in 1962. Ethnic tensions continued to fester and, in 1990, the Tutsi-led Rwandan Patriotic Front (RPF) launched a civil war. Tensions continued and, in April 1994, there was a 3 month genocide in which over a half million were killed, primarily Tutsis. This genocidal killing stopped when the Tutsi-led RPF gradually took control of the country. Today, the country is led by Paul Kagame, an early leader of the RPF. 

...we'll be at Kibogora Hospital in far southwestern Rwanda, near Lake Kivu! It is 100 miles and a 5 hour car ride from the capital city of Kigali.